Using KPC Granular Concentrates
Prescribing granular herb concentrates requires a different reasoning process from that which is used for crude herbs. Calculating the dosage of herb concentrates also demands a unique method, which is quite unlike that used for crude herbs. This paper aims to address these two issues.
Concentrated herb granules are available as single herbs and as prepared formulas. Three strategies exist for combining these two forms:
- Use of one or two classical formulas with or without single herbs.
- Combination of several classical formulas with or without single herbs.
- Combination of single herbs only.
Use of One or Two Classical Formulas With or Without Single Herbs
This strategy uses one or two classical formulas as the base for treatment and adds single herbs to meet the exact needs of the patient. These two cases serve as examples:
Case I.
A patient who suffers from blood vacuity as evidenced by scant menstrual flow, pale tongue, fine pulse and dizziness, also has insomnia. The practitioner selects Si Wu Tang (Tangkuei Four Combination) to address blood vacuity and adds Ye Jiao Teng (Polygonum Multiflorum) and Suan Zao Ren (Zizyphus) to treat the branch symptom of insomnia. A ten day formula was prescribed as follows:
| Si Wu Tang (Tangkuei Four Combination) | 75 grams |
| Ye Jiao Teng (Polygonum Multiflorum) | 15 grams |
| Suan Zao Ren (Zizyphus) | 10 grams |
| Total | 100 grams |
Case II.
A young boy presents with chronic nasal congestion. The practitioner determines from the boy’s pulse, tongue and other signs and symptoms that if this patients had come to her without nasal congestion she would have prescribed Bu Zhong Yi Qi Tang (Ginseng & Astragalus Combination). She decides to use that formula and combine it with Cang Er San (Xanthium Formula). Because the nasal discharge is yellow the practitioner also adds Huang Qin (Scute). A ten day formula is prescribed as follows:
| Bu Zhong Yi Qi Tang (Ginseng & Astragalus Combination) | 25 grams |
| Cang Er San (Xanthium Formula) | 30 grams |
| Huang Qin (Scute) | 5 grams |
| Total | 60 grams |
Combination of Several Classical Formulas With or Without Single Herbs
Taken to the extreme, this strategy employs formulas as if they were single herbs. Three or more formulas are combined to address the complex picture with which the patient presents. Case III and IV are examples of this approach.
Case III.
The young boy with nasal congestion in Case II now, several weeks later, still has nasal congestion (though improved). He presently, however, also has yin vacuity signs such as night heat, excessive thirst and a fine, rapid pulse. The practitioner adds Liu Wei Di Huang Wan (Rehmannia Six Formula), Qing Bi Tang (Pueraria Nasal Combination), Shi Hu (Dendrobium) and Ge Gen (Pueraria Root). The adjusted 10 day formula is as follows:
| Bu Zhong Yi Qi Tang (Ginseng & Astragalus Combination) | 15 grams |
| Cang Er San (Xanthium Formula) | 7 grams |
| Huang Qin (Scute) | 5 grams |
| Liu Wei Di Huang Wan (Rehmannia Six Formula) | 15 grams |
| Qing Bi Tang (Pueraria Nasal Combination) | 8 grams |
| Shi Hu (Dendrobium) | 5 grams |
| Ge Gen (Pueraria Root) | 5 grams |
| Total | 60 grams |
Case IV.
An older gentleman has a diagnosis of prostatitis from his Western medical practitioner and presents with frequent, weak and inhibited urination. He also complains of low back pain that is worse at night when he is fatigued, cold limbs, gas and bloating after eating, low energy, poor sleep and dizziness. The patient’s tongue is pale, with thick fur in the rear. His pulse is fine, moderate and weak. The practitioner decides that the patient suffers from yang vacuity, blood vacuity, and damp-heat in the lower burner. He settles on using Bei Xie Fen Qing Yin (Tokoro Combination) for damp-heat in the lower burner and You Gui Wan (Eucommia & Rehmannia Formula) to supplement yang. Xiang Sha Liu Jun Zi Wan (Saussurea & Cardamon Combination) is added to supplement and rectify qi in the central burner. He Shou Wu (Polygonum) and Ji Xue Teng (Milettia) supplement blood and Yuan Zhi (Polygala) and Yi Zhi Ren (Alpinia Fruit) address frequent urination and insomnia. The ten day formula is as follows:
| Bei Xie Fen Qing Yin (Tokoro Combination) | 40 grams |
| You Gui Wan (Eucommia & Rehmannia Formula) | 15 grams |
| Xiang Sha Liu Jun Zi Wan (Saussurea & Cardamon Combination) | 10 grams |
| He Shou Wu (Polygonum) | 10 grams |
| Ji Xue Teng (Milettia) | 12 grams |
| Yuan Zhi (Polygala) | 5 grams |
| Yi Zhi Ren (Alpinia Fruit) | 8 grams |
| Total | 100 grams |
Combination of Single Herbs Only
This method is used when no formula can be found that meets the patient’s disease pattern or when it is desirable to use only a few herbs. It is important not to use more than twelve herbs for this method, as the amount of each herb would be too small if more herbs than that are used. Ideally, ten or fewer herbs are prescribed when this method is used. An example follows:
Case V.
A fifty year old woman is diagnosed with heart disease by Western medicine. She presents with what Chinese medicine sees as blood stasis and qi vacuity. She is given the following formula (amount is for ten days; 2 grams per dose, 3 times per day):
| San Qi (Pseudoginseng) | 15 grams |
| Dan Shen (Salvia) | 20 grams |
| Ren Shen (Ginseng) | 17 grams |
| Xue Jie (Dragon’s Blood) | 8 grams |
| Total | 60 grams |
Discussion
Of the three strategies here, that of using one or two classical formulas with or without single herbs is the most common. The strength of using formulas as the basis for a prescription is that in the formula the herbs are cooked together before they are concentrated. This closely follows the traditional process used to prepare crude herbs and thus is a more sound strategy than simply mixing single herb concentrates to form a prescription.
The second strategy of combining many formulas together is most often reserved for very complex cases where enduring disorders have created multiple disharmonies. The argument against this strategy is that so little of each herb exists in the final prescription that its effect is limited. Proponents of this strategy counter by insisting that they are using each formula as a functional unit. They claim that a formula once cooked together, is different from a single herb only in that its functions are by design and it is more balanced within itself than a single herb.
The third strategy of mixing only single herbs should be reserved for occasions where there is no classical formula that addresses the patient’s pattern. Given that there are over two hundred and fifty formulas available in concentrated granules, this should be the exception rather than the rule.